We have many patients coming to our ED with cirrhotic liver disease with ascites. Up to 25% of patients with ascites have SBP. Once SBP has been identified, we use a third-generation cephalosporin to treat the patient. However, the benefit of albumin is questionable.
Albumin can bind inflammatory cytokines and improve intravascular volume. Literature suggests that albumin in combination with antibiotics prevents renal impairment and reduces mortality in SBP.
The American Association for the Study of Liver Disease Guideline recommends that patients with SBP who has a serum Cr>1, BUN>30, total Bili > 4, and ascitic fluid PMN>250 should receive 1.5 g/kg within 6 hours of detection. This recommendation originates from a randomized control trial that showed a decrease in mortality from 29% to 10% when comparing SBP patients receiving cefotaxime alone to patients receiving cefotaxime plus albumin.
References:
- http:// rebelem.com/spontaneous-bacterial-peritonitis/
- Runyon BA. Management of Adult Patients with Ascites Due to Cirrhosis: Update 2012. AASLD Practice Guideline
- Sort P, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med 1999;341:403-409.
- Sort P et al. Intravenous albumin in patients with cirrhosis and spontaneous bacterial peritonitis. NEJM 1999; 341: 1773-4
- Sigal et al. Restricted use of albumin for spontaneous bacterial peritonitis. Gut 2007;56: 597-599.
